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Saturday, April 23, 2016

After
ObamaCare, Health Care Anywhere

It is
today possible, to a greater extent than at any time in the world’s history,
for a company to locate anywhere, to use resources from anywhere, to produce a
product that can be sold anywhere.

Milton
Friedman, as quoted in The Sovereign
Individual

The
test of a first-rate intelligence is the ability to hold two opposed ideas in
the mind at the same time and still retain the ability to function.

Scott
Fitzgerald, The Crackup

This week the heath care news foreboded an approaching ObamaCare
crackup – skyrocketing premiums in 2017, exchange enrollments tumbling as people fledfrom exchanges after signing up and getting care,
and a big insurer departing from exchanges because of unsustainable losses.

What manner of health system might follow the crack-up?

Two Part System

I believe it will be a dual system.

·One partwill
be government and integrated health care corporations featuring a vast interoperable
computer system, capable of making sense
out of complexity, integrating information from multiple players and
sources,bringing together data to
diagnose, treat, and managea diversity
of conditions under federal and corporate umbrellas. That will be ObamaCare’s
legacy.

·The other part, of equal size and perhaps of
even greater magnitude , will be a system
consisting of diverse organizations at diverse sites, delivering diverse care anywhere and everywhere, in patients’ homes, at rehab facilities, in doctors’
offices, in urgent care centers, and
often at a distance,virtually,
personally, telemedically, in
cyberspace, outside the realm of government and third parties.

Because of the information revolution, we will see the rapid
emergence of this dual system.The
federal and large organization part will be slow because of political
controversies.But it will be big in the
news because government and political involvement.T

he private,
market-driven segment – more personal, market and customer-based, decentralized,
and diverse will be rapid but less in
the news because it operates under the journalistic radar.It will be more high tech and high touch and more in touch with the will
of the people, their personal feelings,
and their desire for more choices.

Forecasts

The changes will go as Steve Lahr foresaw in the New York Times (High Tech Alternati9ves
to High-Cost Care,” NYT, May 22, 2010).

“Mention health care reform and
the image that springs to mind is a big government program. But there is
another broad transformation in health care underway, a powerful force for
decentralized innovation. It is fueled in good part by technology – low-cost
computing devices, digital sensors, and the Web.”
“The trend promises to shift a lot of diagnosis, monitoring, and treatment of
disease from hospital and specialized clinics where treatment is expensive, to
primary care physicians and patients themselves – at far less cost.”

And as I forecast
in my book, The Health Reform Maze (Greenbranch Publishing, 2011):

“There is something curious and paradoxical
going on out there. It combines high tech, low tech, high touch care
innovations. It is a back-to-the-home movement - a yearning to escape from
hospitals, specialized clinics, specialists, and those health plans we’ve come
to dislike. It seeks high-tech alternatives to high-cost care. It wants high
tech tests done at home by patients at home and monitored by doctors. “

Changes Well Underway

These changes are now
well underway.They are largely customer and
market-based.They are made possible by
sophisticated computer systems and ubiquitous online use anywhere.They are a response by health care consumers and physicians seeking
refuge from unaffordable expenses, inexplicable regulations, and inexcusable
failure of government to deliver on its promises of lower cost more accessible t care.

The Health Reform Maze

Buy the Book

Book Description: In this first book in a series of four, Richard L. Reece, MD. provides a unique view of the roll out, and run up, of the Affordable Care Act. Reece shows in this book the progress and facets of ObamaCare's marketers and messengers, as the day approached for the launch of health insurance exchanges - the single most public and problematic portion of the new law. This is a must read for anyone who wants to chronicle this attempt to organize more than one-sixth of the U.S. economy by adding layers of federal government control and regulations.

Reece has been writing about U.S. health care for more than 45 years. His knowledge and experience, added to his keen intellect and gift of subtle humor, make this book a valuable part of anyone's collection.